Caffeine dependence tied to physical, emotional problems

Erin Allday

Updated 10:45 am, Wednesday, March 5, 2014

Caffeine is ubiquitous in coffee and the idea that the substance can be addictive is hardly new. But for some people, that dependence can be so strong, physically and emotionally, that it becomes problematic. Doctors have a term to describe it - caffeine use disorder - and researchers are developing addiction remedies.
(Pete Kiehart, The Chronicle)

Caffeine is ubiquitous in coffee and the idea that the substance...

Caffeine is ubiquitous in coffee beans and the idea that the substance can be addictive is hardly new.
(Lance Iversen, The Chronicle)

Caffeine is ubiquitous in coffee beans and the idea that the...

A line of customers at a Blue Bottle coffee in San Francisco.
(Liz Hafalia, The Chronicle)

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It's 4 in the afternoon, and Adam Sandoval, a San Francisco handyman who starts work very early most mornings, is finishing up his second 16-ounce tumbler of black coffee for the day.

"I've tried to quit it, but I get headaches," Sandoval, 47, said with a shrug. "So I stopped using sugar and cream. That's the bad stuff. Now I just drink it straight, and it feels like I'm getting more caffeine somehow."

Sandoval may be dependent on his daily coffee buzz, but it's not something he worries about. Like millions of Americans, he doesn't see much of a downside to the regular shots of caffeine.

But for some people, that dependence can be so strong, physically and emotionally, that it becomes problematic. There's even a medical term to describe it: caffeine use disorder.

"Caffeine has caused significant problems for some people," said Laura Juliano, a psychology professor at American University in Washington, D.C., and part of a team of researchers studying the harmful effects of caffeine use disorder.

"We have people who say caffeine is interfering with their life. They keep saying they're going to stop, but they can't," she said. "I've seen people who have gone to great lengths to get caffeine when it was unavailable. I knew one woman who pretty much ruined her husband's tropical vacation because she spent half the day looking for caffeine."

Caffeine may be ubiquitous in American culture - some reports suggest up to 90 percent of people in the U.S. regularly consume it - and the idea that caffeine can be addictive is hardly new.

Most of the research into caffeine involves its potential health benefits and risks as a drug. For the most part, evidence suggests that caffeine is probably benign in moderate doses. But multiple studies have shown positive health benefits associated with regular caffeine consumption - it may protect against diabetes and Alzheimer's disease, for example, or help treat depression.

But when it comes to misuse of caffeine, astonishingly little data exist about how widespread the problem is, Juliano said.

That may be in part because most people - from the Blue Bottle fanatics to addiction specialists and laboratory chemists - don't see caffeine as an especially dangerous drug. It's certainly safe in small doses, and even in excessive amounts, the worst effects usually are symptoms like headaches, anxiety and jittery hands.

"We're not talking about cancer here. It's a quality-of-life issue," said Dr. Robert Cowan, director of the Stanford Headache Program.

When he sees patients with chronic headaches, one of the first questions he asks is how much caffeine they consume. The caffeine doesn't necessarily cause the headaches, but the withdrawal can, and even going a few hours without a cup of coffee can cause some people intense pain.

"I tell patients, 'If you'd rather have daily headaches than give up your caffeine, you can make that choice.' It's not a life-or-death situation," Cowan said.

Difficult to cut back

Other doctors report having similar conversations with patients. Cardiologists have told patients to cut back on coffee because they're having heart palpitations, and psychologists have warned people that their caffeine habit may be adding to their anxiety problems. Yet some people have trouble letting go of the caffeine - or even cutting back - because it feels like a necessity.

Even sleep experts say patients will complain of insomnia but shudder at the idea of quitting caffeine.

"There are people who have chronic reflux, stomach acid pain, bleeding, hemorrhoids - all because of coffee. They're suffering a lot," said Keith Humphreys, a Stanford addiction expert. "But they try and they fail to stop."

Those people may be addicted to caffeine, he said. But he's loath to apply that label to most people who regularly use caffeine, even those who are physically dependent on it. For something to be considered an addiction, it needs to truly disruptive - causing problems in personal relationships, for example, or interfering with the ability to work.

Plus, most people can usually cut back on their caffeine consumption without quitting altogether, unlike truly addictive drugs such as alcohol or heroin.

Still, Juliano said, for some people caffeine overuse can be disruptive. There's very little research into the subject, but one study found that roughly 1 in 10 people met the most important diagnostic criteria for caffeine use disorder.

Those people said they wanted to cut down on their habit, that they were using the drug despite knowing that it was causing them harm, and they suffered withdrawal symptoms when they tried to quit. All three criteria together suggest disordered consumption, according to researchers in that study, which was done in Vermont.

Treatment programs

Even if only a small minority of caffeine users are having problems controlling their habit, that still could be a large number of people, Juliano said. If just 1 percent of the millions of caffeine consumers are in trouble, that's still thousands of people, she pointed out.

Now, Juliano and her colleagues are developing treatment programs specific to caffeine, addressing issues such as counseling, coping strategies and consumer education. Their first study of a new treatment technique may be published this year.

In the meantime, she'd like to make consumers - and doctors - better aware of the role that caffeine may be playing in their daily lives.

Most people don't even know for sure how much caffeine they're drinking, because amounts can vary widely among beverages. A mug of coffee brewed at home may have 100 milligrams of caffeine, while a 16-ounce beverage at Starbucks can have more than 300 milligrams.

Caffeine headaches

People often are so used to their daily fix that when they accidentally go without, they don't understand why they suddenly feel fatigued and headachy, Juliano said. Studies have even found that patients who have surgery sometimes wake up with headaches that aren't from the anesthesia, but from missing a morning cup of coffee.

"My wife has to prep for Yom Kippur," the Jewish holiday that involves a day of fasting, said Dr. Daniel Saal, psychiatrist in the chemical dependency recovery program at Kaiser Santa Clara.

"There is a legitimate withdrawal phenomenon, and it's not rare. It's extremely common," Saal said. "But I would not think of caffeine as an addiction in most patients. It's not on the top of my list of concerns."